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Biomedical subjects

C A Brailovsky

Publications and source records attributed to C A Brailovsky.

At least 19 recordsLinked to original sources
PubMed2000

Does the site of postgraduate family medicine training predict performance on summative examinations? A comparison of urban and remote programs.

BACKGROUND: The location of postgraduate medical training is shifting from teaching hospitals in urban centres to community practice in rural and remote settings. We were interested in knowing whether learning, as measured by summative examinations, was comparable between graduates who trained in urban centres and those who trained in remote and rural settings. METHODS: Family medicine training programs in Ontario were selected as a model of postgraduate medical training. The results of the 2 summative examinations--the Medical Council of Canada Qualifying Examination (MCCQE) Part II and the College of Family Physicians of Canada (CFPC) certification examination--for graduates of the programs at Ontario's 5 medical schools were compared with the results for graduates of the programs in Sudbury and Thunder Bay from 1994 to 1997. The comparability of these 2 cohorts at entry into training was evaluated using the results of their MCCQE Part I, completed just before the family medicine training. RESULTS: Between 1994 and 1997, 1013 graduates of family medicine programs (922 at the medical schools and 91 at the remote sites) completed the CFPC certification examination; a subset of 663 completed both the MCCQE Part I and the MCCQE Part II. The MCCQE Part I results for graduates in the remote programs did not differ significantly from those for graduates entering the programs in the medical schools (mean score 531.3 [standard deviation (SD) 69.8] and 521.8 [SD 74.4] respectively, p = 0.33). The MCCQE Part II results did not differ significantly between the 2 groups either (mean score 555.1 [SD 71.7] and 545.0 [SD 76.4] respectively, p = 0.32). Similarly, there were no consistent, significant differences in the results of the CFPC certification examination between the 2 groups. INTERPRETATION: In this model of postgraduate medical training, learning was comparable between trainees in urban family medicine programs and those in rural, community-based programs. The reasons why this outcome might be unexpected and the limitations on the generalizability of these results are discussed.

Analysis of Variance↗
PubMed1998

[Interobserver agreement on diagnoses classified according the International Classification of Primary Care].

OBJECTIVE: To measure interobserver agreement on diagnoses classified and coded by family physicians using manual or computerized input modes. METHOD: Used increasingly in a variety of information management systems, the International Classification of Primary Care is the system best adapted to primary care. Ten physicians independently viewed 44 taped medical visits. Five physicians were randomly assigned to manual coding and five to computer coding. The study of reproducibility explored three aspects: written diagnoses, manually coded diagnoses, and diagnoses coded using a software program. The K statistic was calculated in order to compare interobserver agreement. RESULTS: Descriptive analysis of interobserver agreement in the written diagnoses revealed an agreement rate of 70.5% (+/- 6.3). Among physicians using manual coding, the agreement rate was 70.2% (+/- 7.2). In the group using the software program, the agreement rate was 75.0% (+/- 8.7). The K coefficients were low, but three were significant with critical ratios (z) above 1.96. CONCLUSION: Results suggest that input method has no bearing on interobserver agreement and that agreement is more a function of clinical presentation of health problems than of coding process.

Abstracting and Indexing↗
PubMed1997

Using standardized patients in licensing/certification examinations: comparison of two tests in Canada.

BACKGROUND: A new licensing examination for family physicians was introduced in the Province of Quebec, Canada, in 1990. It contains a newly developed, standardized, patient-based objective structured clinical examination (OSCE) used in complementarity with two other instruments (Short Answers Management Problems [SAMPs] and Simulated Office Orals [SOOs]) that have been used for many years by the College of Family Physicians of Canada (CFPC) for certification purposes. This research studied the criterion validity of the OSCE using the last instruments as criteria. METHODS: The results of the 172 spring 1994 candidates were analyzed. Cronbach alpha reliability coefficients were computed. Pearson's correlation coefficients and regression analysis measured the extent to which scores on the new Quebec OSCE correlated with the scores on the CFPC instruments. RESULTS: Correlation coefficients were significant between the Quebec OSCE scores and the CFPC examination total scores (.700), the SAMPs scores (.634), and the SOOs scores (.514). Multiple regression analysis confirmed that scores on the Quebec OSCE explained a significant but still limited proportion of the variation in scores of the CFPC examination. DISCUSSION: This study supports the criterion validity of the Quebec OSCE used in the licensing examination. However, differences in the skills assessed by each instrument and in the clinical situations presented exist between the Quebec instrument and the two national instruments. These differences, plus the variation in the scores obtained by the candidates on the three instruments, support the decision of the Quebec licensing organization to use them in complementarity.

Canada↗
PubMed1996

Content validity of the Quebec licensing examination (OSCE). Assessed by practising physicians.

OBJECTIVE: To assess content validity of the objective structured clinical examination (OSCE), which uses multiple encounters with standardized patients and which is included in the Quebec licensing examination (QLEx). DESIGN: Descriptive study using written questionnaires based on Likert-type scales. SETTING: Examination centres of the QLEx. PARTICIPANTS: Thirteen practising family physicians with 3 to 6 years' practice experience who passed the QLEx OSCE in May 1993. MAIN OUTCOME MEASURES: Opinion whether the QLEx OSCE globally measured the competence of family physicians; opinion whether OSCE cases and stations made it possible to assess the main clinical abilities required of a family physician; opinion on specific statements about each case, such as how frequently the case was seen in the participants' practice, if the participants knew how to deal with the problem, if the simulated patient was believable, if the clinical situation was realistic, and if the duration of the station was adequate; and participants' self-assessment of their performance on the case. RESULTS: Eleven participants (84.6%) agreed that the OSCE globally measured the competence of a family physician. All agreed that the OSCE cases and stations made it possible to assess the main clinical skills required of a family physician. For most of the cases, participants believed that they knew how to deal with the problem, that the clinical situation was realistic, that the simulated patient was believable, and that the case duration was adequate. CONCLUSIONS: The results of this study support the content validity of the QLEx OSCE and confirm that it assesses the main skills needed for practising family medicine and adequately samples possible encounters or cases seen in family practice.

Adult↗
PubMed1995

Residency directors' predictions of candidates' performances on a licensing examination.

PURPOSE: To look at how well residency directors in family medicine predict the performances of their candidates on the Quebec Licensing Examination (QLEx) for family physicians. METHOD: The four family medicine program directors in Quebec were asked in the spring of 1992 to identify the ten residents from their own programs who would get the highest marks on the QLEx and the ten who would get the lowest marks. From the results of these candidates, and those of the intermediate groups defined by default, the prediction abilities of the program directors were assessed. RESULTS: Descriptive statistics showed that the program directors had difficulties discriminating among the different groups and tended to collapse the predicted scores toward the total mean. Analysis-of-variance studies confirmed the absence of difference between the predicted weak and intermediate groups as well as between the predicted intermediate and strong groups for each program and for each QLEx component. Regression analysis as well as eta 2 studies showed that the program directors' prediction abilities were low for all components and represented less than 25% of the explained variance of the QLEx scores. CONCLUSION: The residency directors did not accurately categorize their residents' performances on the QLEx. Both the evaluations of program directors and terminal examination results are complementary approaches to clinical competence assessment and should be used for licensure.

Educational Measurement↗
PubMed1993

Canadian experience with structured clinical examinations.

The use of structured clinical examinations to improve the evaluation of medical students and graduates has become significantly more common in the past 25 years. Many Canadian medical educators have contributed to the development of this technique. The Canadian experience is reviewed from the introduction of simulated-standardized patients and objective-structured clinical examinations to more recent developments and the use of such examinations for licensure and certification.

Canada↗
PubMed1992

Large-scale use of an objective, structured clinical examination for licensing family physicians.

Since 1988 in Quebec the completion of a residency training program in family medicine or a specialty and of a comprehensive examination has been necessary to obtain a licence. An objective, structured clinical examination (OSCE) was designed by the Corporation professionnelle des médecins du Québec and Quebec's four medical schools to evaluate the clinical competence of newly trained family physicians. The certification examination of the College of Family Physicians of Canada was added to the OSCE. More than 500 candidates have been assessed: 262 in the spring of 1990, 42 in the fall of 1990 and 235 in the spring of 1991. The spring session occurs in four centres, three offering it in French and one in English, and the fall session takes place in one bilingual centre. In each centre 25 standardized patients and 25 examiners are required on each day of the 2-day OSCE. The scores obtained by the candidates who completed the OSCE in the first three sessions showed a normal distribution. No more than 5% failed the OSCE, the pass level having been set at two standard deviations below the mean. Equivalence was shown among the OSCE tracks, and reliability coefficients of 0.644, 0.723 and 0.736 were obtained for the three sessions respectively. The overall success rate for the licensing examination was 92%. The integration of such a large-scale OSCE into a licensing examination and the results obtained show that assessment of clinical competence for licensing purposes is feasible. The Quebec experience may help other organizations that are developing OSCEs for summative purposes.

Certification↗
PubMed1985

Modulation of the immunosuppressive effects of splenic macrophages in Fischer rats bearing adenocarcinoma 13762.

The nature of spleen cells in Fischer rats bearing a large size (greater than 1 cm diameter) mammary adenocarcinoma 13762A (MAC) which block the immunostimulating capacities of MTP2 (a synthetic immunomodulator) and suppress proliferation in vitro of splenic T and B lymphocytes by their respective mitogens was investigated. Splenic macrophages were recognized as the suppressor cells by (a) restoration of mitogenic responses by depletion of macrophages from spleen cell suspensions and (b) continued suppressor activity in spleen cell suspensions of tumor bearers devoid of viable T lymphocytes. Macrophage contact with T lymphocytes was required for the inhibition of T lymphocyte proliferation by concanavalin A as shown by (a) the absence of suppressor activity in supernatants derived from cultured suppressor macrophages, (b) lowering of the suppressor activity of intact macrophages after treatment with neuraminidase, (c) lowering of the suppressor activity of macrophages by addition of red cells to spleen cultures of tumor bearers indicating red cell interference with macrophage-T cell interaction and (d) lack of inhibiting action of suppressor macrophages on allogenic T lymphocyte proliferation showing macrophage T cell recognition for suppression. Animals bearing a large size tumor exhibited spleen hypertrophy and an increase in macrophage: lymphocyte ratio and a decrease in red cell: lymphocyte ratio. Splenic macrophages did not appear to be implicated in blocking antitumor immunity induction since (a) suppressor macrophages were absent in spleens during the inductive phase of the immune response and (b) MAC implanted in allogenic Wistar rats grew to about 2 cm diameter, induced splenic suppressor macrophages but the tumor was later rejected by the animals. Collectively the results suggest that suppressor macrophages are the result of increasing tumor volume rather than its cause.

Adenocarcinoma↗
PubMed1985

Combination of 60Co gamma-radiation, misonidazole, and maltose tetrapalmitate in the treatment of Dunning prostatic tumor in the rat.

Maltose tetrapalmitate (MTP), a synthetic nontoxic immunoadjuvant, the radiosensitizer misonidazole (MISO), and 60Co gamma-radiation, alone or in combination, were used in the management of Dunning prostatic tumor in the rat. Nine groups of 10 rats each were used to assess the efficacy of various therapeutic modalities. Tumor growth rates and animal survival times were determined for each group. Radiation was more effective when combined with MTP, but the adjuvant must be present when radiation is given for synergism to occur. MISO was as effective as MTP when used with radiation, but combining them cancels out their individual effects. In a clinical situation it would be advantageous to use separately the synergisms existing between MISO and radiation on the one hand and MTP and radiation on the other hand.

Adjuvants, Immunologic↗
PubMed1985

Induction of antitumor immunity employing live tumor cells and maltose tetrapalmitate.

Several protocols employing a new immunoadjuvant, maltose tetrapalmitate (MTP), were tried in an effort to obtain immunization against a weakly immunogenic transplantable mammary adenocarcinoma, 13762, in syngeneic Fischer rats. Effectiveness of immunization was measured by rejection of tumor or reduction in tumor growth, by alteration in survival time after tumor challenge, and by proliferation in vitro of spleen cells of animals tumor-sensitized by killed tumor cells and tumor extracts. No success in the induction of tumor rejection was achieved by employing killed tumor cells or 3 M KCl tumor extracts used in either the presence or absence of MTP. Only a low dose of viable tumor cells elicited tumor rejection immunity when combined with MTP treatment given three times weekly. Spleen cell proliferation of tumor-sensitized animals was obtained in the case of live cells and 3 M KCl extract immunization, and was specific for the type of antigen (killed cells or soluble) preparation employed.

Adjuvants, Immunologic↗
PubMed1984

In vitro spleen cell proliferation following in vivo treatment with a synthetic glycolipid or lipid A in three mouse strains.

Synthetic glycolipid, maltose hexastearate (MHS), like LPS or lipid A is a B cell mitogen for outbred Swiss mice, inbred C3H/HeN and C3H/HeJ X C3H/HeN F1 hybrid but not for C3H/HeJ mice. MHS administered i.p. (10 micrograms) to Swiss, C3H/HeN, C3H/HeJ and C3H/HeJ X C3H/HeN F1 hybrid mice confers within 90 min an increased ability in the spleen cell populations such that they exhibit increased incorporation of 3H thymidine into cellular DNA in vitro. The spleen cells of MHS treated mice also respond in vitro more vigorously than controls to a T cell mitogen (Con A) but not at all differently from controls to a B cell mitogen (LPS). The stimulated cells are sensitive to anti theta serum + C' (experiment done with Swiss mice) and the Lyt 1,1 monoclonal antibody + C' (experiment done with C3H/HeN mice), indicating them functionally to be of T-helper variety. Unlike MHS, lipid A administration i.p. resulted in MHS like response in C3H/HeN but not in C3H/HeJ mice. MHS action has been traced to an induction of IL1 release by macrophages of MHS treated animals by chromatographic analysis of macrophage derived supernatants. IL1, in turn, according to the prevalent concepts would stimulate immature T cells to become mature IL2 producer cells, allowing T helper cell proliferation through IL2 release.

Adjuvants, Immunologic↗
PubMed1984

Combined cyclophosphamide chemotherapy and maltose tetrapalmitate immunotherapy in the treatment of transplanted bladder and prostate carcinoma of the rat.

Chemoimmunotherapy in two animal models for urological cancers was studied. The models were Dunning R3327A prostatic carcinoma transplanted s.c. in Fischer X Copenhagen F1 hybrids and a well-differentiated bladder carcinoma transplanted orthotopically in the bladder submucosa of female Fischer rats. Cyclophosphamide, cis-platinum, and Adriamycin were initially used as anticancer chemotherapeutic agents, and the most effective ones were used in combination with maltose tetrapalmitate (MTP), which was used as an immunopotentiator. In the case of prostatic carcinoma, cyclophosphamide was the most effective among the anticancer agents in controlling tumor growth after inoculation of either 10(4) or 10(5) tumor cells. Combination of cyclophosphamide with i.p. MTP delayed tumor take and controlled tumor size more effectively than did either of the treatments given alone. Similar results were obtained in the case of bladder tumor. A combination of cis-platinum with MTP significantly controlled bladder tumor size, and a combination of cyclophosphamide with MTP cured 75% of the rats. The remaining 25% of this group had a small tumor that did not increase in size during the subsequent 2 weeks of observation without treatment. The incidence of metastasis of bladder tumor to lymph nodes and lung was reduced by MTP and cis-platinum and eliminated by cyclophosphamide alone and in combination with MTP. Nonspecific immunity as measured by phytohemagglutinin stimulation of spleen lymphocytes and antitumor immunity as measured by cytotoxicity and macrophage migration inhibition assays were highest in rats subjected to cyclophosphamide and MTP combined therapies.

Animals↗
PubMed1983

Systemic, bladder wall, and bladder tumor concentration of misonidazole following intravesical administration in the rat.

The hypoxic-cell radiosensitizer misonidazole was administered intravesically to normal and to bladder tumor-bearing female Fischer rats. Drug concentration was measured in the bladder wall, the tumor and in the serum using high pressure liquid chromatography at different times following administration. The data shows that misonidazole is readily adsorbed by the bladder wall and the tumor with tissue levels reaching up to 10 times those measured in the serum.

Animals↗